Neuroimaging Technique Raises Stroke Treatment Standard

Dr. Leo Wolansky, chair of the UConn Health Department of Radiology, shows the types of images CT perfusion scanning yields to help determine the best course of action in stroke treatment.

UConn John Dempsey Hospital is among only a few hospitals in the state to offer a new neuroimaging technique to patients who’ve suffered the most common type of stroke, potentially quadrupling the narrow window for intervention to 24 hours from the onset of symptoms.

This helps physicians determine which patients are good candidates for a highly specialized neurosurgical and interventional radiological procedure called mechanical thrombectomy. The lifesaving procedure is only available at a few hospitals in the state; UConn Health Chief of Neurosurgery Dr. Ketan Bulsara performed UConn John Dempsey Hospital’s first-ever mechanical thrombectomy in November.

“It enables us to easily check how large an area of the brain is deprived of blood flow,” says Dr. Leo Wolansky, chair of the UConn Health Department of Radiology. “We can distinguish between the part of the brain that’s already dead [cerebral infarction] and the part of the brain that is in danger of dying [ischemic] but can be saved.”

In October, UConn Health rolled out the perfusion imaging program a week after processing its first functional MRI case for surgical guidance. The innovations are part of a system-wide initiative by UConn Health leadership to provide cutting-edge technology and recruit top physicians familiar with its use, such as Wolansky, in order to provide the finest care for neurological conditions.

Historically, when a patient has cerebral infarction, the most common type of stroke, the race is on to administer a clot-dissolving medication known as a tissue plasminogen activator (TPA). Mechanical thrombectomy traditionally has also been an option with a very limited timespan. With the introduction of advanced imaging such as RAPID, patients now can be treated safely for up to 24 hours of their stroke if the CT perfusion scan is favorable.

“We can tell if there is brain that can be saved, even beyond the previously accepted window of time for thrombectomy,” Wolansky says. “This creates the possibility of treating many ‘wake-up’ strokes, people who went to sleep well, but woke up eight hours later with a stroke.”

The results of a major study known as the DAWN trial, released in May 2017, showed good outcomes for stroke patients who were treated with thrombectomy up to 24 hours after the event.